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Residents' Engagement in Quality Improvement: A Systematic Review of the Literature

Patow, Carl A. MD, MPH, FACS; Karpovich, Kelly; Riesenberg, Lee Ann PhD, RN; Jaeger, Joseph MPH; Rosenfeld, Joel C. MD, MEd; Wittenbreer, Mary MLIS, MALS; Padmore, Jamie S.

doi: 10.1097/ACM.0b013e3181bf53ab
Quality and Safety

Purpose Residents are being asked to participate in quality improvement (QI) initiatives in hospitals and clinics with increasing frequency; however, the effectiveness of improving patient care through residents' participation in QI initiatives is unknown.

Method A thorough, systematic review of the English-language medical literature published between 1987 and October 2008 was performed to identify clinical QI initiatives in which there was active engagement of residents. Multiple search strategies were employed using PubMed, EMBASE, CINAHL, and ERIC. Articles were excluded in which residents played a passive or peripheral role in the QI initiative.

Results Twenty-eight articles were identified that documented residents' active leadership, development, or participation in a clinical QI initiative, such as curriculum change, clinical guideline implementation, or involvement with a clinical QI team. The role and participation of residents varied widely. Measures of patient health are described as outcomes in the QI initiatives of 5 of the 28 articles. Twenty-three articles described process improvements in patient care or residents' education as the outcome measure.

Conclusion There are few articles that describe the clinical or educational effectiveness of residents' participation in QI efforts; the authors describe barriers that may be partly responsible. They conclude that there is a great need for additional research on the effectiveness of residents' participation in QI initiatives, particularly as they affect patient health outcomes.

Dr. Patow is executive director, HealthPartners Institute for Medical Education, and associate dean for faculty affairs, Regions Hospital, University of Minnesota Medical School, Minneapolis, Minnesota.

Ms. Karpovich is director, Medical Education-Baltimore, MedStar Health, Columbia, Maryland.

Dr. Riesenberg is director of medical education research and outcomes, Academic Affairs, Christiana Care Health System, Newark, Delaware, and research assistant professor, Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania.

Mr. Jaeger is associate vice president, Academic Affairs, Monmouth Medical Center, Long Branch, New Jersey, and associate dean, Academic Affairs, Monmouth Programs, Drexel University College of Medicine, Philadelphia, Pennsylvania.

Dr. Rosenfeld is chief academic officer, St. Luke's Hospital and Health Network, Bethlehem, Pennsylvania, and associate dean, Temple University School of Medicine, Philadelphia, Pennsylvania.

Ms. Wittenbreer is librarian, Regions Hospital Medical Library, St. Paul, Minnesota.

Ms. Padmore is assistant vice president, Academic Affairs, MedStar Health, Columbia, Maryland.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. Patow, HealthPartners Institute for Medical Education, 8170 33rd Ave S, MS21110T, Minneapolis, MN 55425; telephone: (952) 883-7185; fax: (952) 883-7181; e-mail: (

© 2009 Association of American Medical Colleges